Results

Provider Attitudes and Behaviors for Antibiotic Prescribing in the Emergency Department (ED) Larissa May, MD, MSPH1, Gillian Brooks1, Paige Armstrong, MD, MS1, Rahul Bhat, MD2, Gregory Moran, MD3, Kristen Breslin, MD, MPH4, Lisa Schwartz, EdD1, Sara Cosgrove, MD, MS5, Richard Rothman, MD, PhD5, and Cynthia Rand, PhD5

1. The George Washington University, Washington, DC 2. Georgetown University, Washington, DC 3. David Geffen School of Medicine at UCLA, Los Angeles, CA 4. Children's National Medical Center, Washington, DC 5. The Johns Hopkins Medical Institutions, Baltimore, MD

Background Methods

•

Objectives

Funding/Acknowledgements

Contact

Larissa May, MD MSPH

Emergency Medicine

2120 L Street, NW, Suite 450

Washington, DC 20037

Phone: 202-741-2920

Email: larissa@gwu.edu

Poster 1024

Survey-based study of ED clinicians

(attending physicians, emergency medicine

residents, and midlevel providers) from eight

academic sites

Survey instrument modified from prior surveys

on antimicrobial stewardship1,2

Administered via RedCap, a secure web

application

SAS 9.3 was used for all analyses

"This project was supported by Award

Number UL1TR000075 from the NIH

National Center for Advancing

Translational Sciences. Its contents are

solely the responsibility of the authors and

do not necessarily represent the official

views of the National Center for Advancing

Translational Sciences or the National

Institutes of Health."

Preliminary Conclusions

Limitations

1. Srinivasan A, Song X, Richards A, Sinkowitz-

Cochran R, Cardo D, Rand C. A survey of

knowledge, attitudes, and beliefs of house staff

physicians from various specialties concerning

antimicrobial use and resistance. Arch Intern

Med. 2004 Jul 12;164(13):1451-6.

2. Abbo L, Sinkowitz-Cochran R, Smith L, Ariza-

Heredia E, Gómez-Marín O, Srinivasan A, Hooton

TM. Faculty and resident physicians' attitudes,

perceptions, and knowledge about antimicrobial

use and resistance.Infect Control Hosp

Epidemiol. 2011;32(7):714-8.

References .

• The Emergency Department (ED)

provides a unique opportunity to observe

prescribing behaviors that may be

associated with increasing antibiotic-

resistant bacteria.

• ED is a critical site to address reduction

of inappropriate antimicrobial use.

• Targeted messaging and decision

support tools may promote adherence to

clinical practice guidelines.

• Paucity of literature on ED provider

knowledge, attitudes and behaviors

(KAB) regarding antimicrobial prescribing

that could inform interventions.

• To assess ED provider KAB for

antimicrobial prescribing.

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CLINICIAN CHARACTERISTICS

• Survey based (participant, self-reporting

and social desirability biases)

• Small sample size

• Did not include community EDs

• Analysis of qualitative outcomes with

quantitative approach

Characteristic

(n=142) Frequency (%)

Age <30: 25% 31-40: 55% 41-50: 12% >50: 8%

Gender Female: 50% Male: 50%

Title Attending: 59% Resident: 36%

Type of Location Urban Tertiary Academic Centers:

64%

19% (residents) rotate in a

Community Tertiary Hospital

Urban County Hospital: 18%

49% (residents) rotate with an Urban Tertiary Academic Hospital Military Treatment Facility:16% Urban Academic Pediatric Center:15%

Years in Practice Attendings:

Mean=11.5 y (1 y, 37 y)

Residents:

Mean=2.5 y (0.4 y, 5 y)

Characteristic Attendings (n=88) Residents (n=54) p

Confidence of

using antibiotics

optimally for

patients being

discharged

Very Confident : 30%

Somewhat Confident: 61%

Somewhat Unconfident: 9%

Very Unconfident: 0%

Very Confident: 4%

Somewhat Confident: 81%

Somewhat Unconfident:13%

Very Unconfident: 2%

0.0007

Confidence of

using antibiotics

optimally for

patients being admitted

Very Confident : 33%

Somewhat Confident: 59%

Somewhat Unconfident: 7%

Very Unconfident: 1%

Very Confident : 26%

Somewhat Confident: 67%

Somewhat Unconfident: 7%

Very Unconfident: 0%

0.48

If it was provided to

you via smart

phone or iPad, how

useful would you

find an on-line

decision support

tool for antibiotic

selection in your ED practice?

Extremely Useful: 44%

Somewhat Useful: 44%

Not Very Useful: 5%

Not Useful At All: 2%

Don’t Know: 5%

Extremely Useful: 72%

Somewhat Useful: 26%

Not Very Useful: 0%

Not Useful At All: 0%

Don’t Know: 2%

0.0009

If antibiotic

recommendations

were embedded in

the EMR, how

useful would you

find an on-line

decision support

tool for antibiotic

selection in your ED practice?

Extremely Useful: 51%

Somewhat Useful: 40%

Not Very Useful: 5%

Not Useful At All: 1%

Don’t Know: 3%

Extremely Useful: 60%

Somewhat Useful: 31%

Not Very Useful: 3%

Not Useful At All: 2%

Don’t Know: 4%

0.42

If it was provided to

you via smart

phone/iPad, would

you use an online

decision support

tool for antibiotic

selection in your

ED practice?

Definitely: 41%

Probably: 42%

Probably Not: 16%

Definitely Not: 1%

Definitely: 70%

Probably: 24%

Probably Not: 0%

Definitely Not: 1%

0.0008

If antibiotic

recommendations

were embedded in

the EMR, would

you use an on-line

decision support

tool for antibiotic

selection in your ED practice?

Definitely: 49%

Probably: 46%

Probably Not: 4%

Definitely Not: 1%

Definitely: 52%

Probably: 41%

Probably Not: 7%

Definitely Not: 0%

0.95

Agreement with

statement

“Antibiotics are

overused in the

ED”

Strongly Agree: 31%

Agree: 56%

Neutral: 9%

Disagree: 4%

Strongly Disagree: 0%

Strongly Agree: 13%

Agree: 44%

Neutral: 32%

Disagree: 11%

Strongly Disagree: 0%

<.0001

I get useful

feedback on my antibiotic selections

Strongly Agree: 1%

Agree: 6%

Neutral: 12%

Disagree: 52%

Strongly Disagree: 29%

Strongly Agree: 4%

Agree: 24%

Neutral: 20%

Disagree: 32%

Strongly Disagree: 20%

0.003

Antibiotic

resistance does not

present a

significant problem

in the ED at my institution

Strongly Agree: 1%

Agree: 2%

Neutral: 12%

Disagree: 50%

Strongly Disagree: 35%

Strongly Agree: 0%

Agree: 7%

Neutral: 7%

Disagree: 63%

Strongly Disagree: 22%

0.21

Antibiotics are

overused in non-

ED settings at my institution

Strongly Agree: 34%

Agree: 40%

Neutral: 21%

Disagree: 5%

Strongly Disagree: 0%

Strongly Agree: 19%

Agree: 41%

Neutral: 30%

Disagree: 7%

Strongly Disagree: 3%

0.02

SURVEY RESPONSES

ED attendings are more aware of the

problem of antibiotic overuse than residents.

Despite most ED clinicians reporting poor

feedback on antibiotic selection, most felt

confident in their prescribing patterns

Most clinicians in the ED support use of

electronic decision-making tools for

antibiotic selection vs. embedding antibiotic

recommendations in the EMR.

Differences in how trainees access

information may necessitate multiple

strategies to reduce inappropriate

prescribing in academic EDs.

Further research should focus on ED-

tailored interventions to address antibiotic

overuse.